Kudikira, Chemotherapy, Matenda a Monoclonal, kapena Kusintha kwa Cell Stem kwa CLL
Kodi njira zabwino kwambiri zothandizira chronic lymphocytic leukemia (CLL) ndi ziti?
Ndemanga ya Chronic Lymphocytic Leukemia (CLL)
Ngati mumadziŵa bwino zizindikiro ndi zoopsa za CLL , ndipo mwadutsa matendawa a CLL mwakonzeka kuti mutenge gawo lotsatira. Ndipotu, mwamvapo zambiri zokhudza mankhwala osiyanasiyana omwe alipo pa khansa.
N'zomvetsa chisoni kuti panthawiyi palibe mankhwala amene amachitidwa kuti ndi mankhwala ochizira matenda a khansa (CLL). Koma ngakhale popanda mankhwala, anthu ena akhoza kukhala ndi moyo kwa zaka zambiri komanso ngakhale zaka zambiri. Pakalipano, chithandizochi chimapatsa odwala chitonthozo ku zizindikiro zawo, ndi chiyembekezo chotsimikizira moyo wabwino ndi kukhululukidwa kwa nthawi yaitali.
Yang'anani ndi Dikirani
Odwala omwe sakhala ndi zizindikiro za CLL, monga kutuluka usiku, malungo, kulemera kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi, thrombocytopenia (matenda ochepa a platelet) kapena matenda opatsirana nthawi zambiri sangapindule ndi chithandizo. Mankhwala omwe ali panthawiyi mu matendawa sadzapitilira moyo wanu, komanso sadzachepetsanso kukula kwa khansa ya m'magazi. Choncho, njira yowonetsera kuyembekezera nthawi zambiri imatengedwa. Mukakhala mukudikirira, mudzatsatiridwa ndi katswiri wa zamagazi kapena a oncologist ndipo mukuyenera kukhala ndi ntchito ya magazi ndikuwoneka ndi katswiri wanu miyezi isanu ndi umodzi kapena 12.
Pakati pa maulendo, muyenera kusamala zizindikiro zomwe khansa yanu ikukulirakulira. Mutha kuzindikira:
- Kutupa m'matumbo anu
- Kusokonezeka m'mimba kapena kupweteka
- Zizindikiro za kuchepa magazi m'thupi monga kutopa khungu komanso kumva kutopa kwambiri
- Matenda obwerezabwereza kapena matenda omwe satha
- Matenda odzola kapena kupweteka kosavuta
Odwala ambiri akhoza kukhalabe maso ndikudikirira zaka zambiri asanafune chithandizo cha CLL yawo . Zingakhale zovuta kwambiri kuti muphunzire kuti muli ndi khansa, ndiye "dikirani kuti iziipira" musanayambe kuchichita. Mwinamwake mungamve ngati mumangofuna kulimbana ndi khansa ya m'magaziyi kuti muipeze!
Ngakhale zingakhale zovuta kuti mukhale oleza mtima, nkofunika kuti muzindikire kuti ulonda ndi kuyembekezera ndi nthawi yomwe CLL sichisonyeza zizindikiro zirizonse. Kafukufuku wapaderawa sanawonetse ubwino uliwonse woyambira chithandizo msanga.
Chemotherapy
Kwa zaka zambiri, mankhwala am'kamwa ndi Leukeran (chlorambucil) anali ofanana ndi mankhwala a CLL kamodzi kansara itayamba kukula. Ngakhale kuti odwala ambiri anachita bwino pa chithandizochi, sizinapereke yankho lathunthu (CR) kawirikawiri. Masiku ano, chlorambucil imagwiritsidwa ntchito kwa odwala omwe ali ndi mavuto ena azaumoyo omwe amalepheretsa kulandira mankhwala amphamvu kwambiri, omwe amachititsa kuti mankhwalawa asokonezeke.
Posachedwapa, Fludara (fludarabine) chemotherapy yasonyezedwa kuti ikugwira ntchito pochiza CLL osatembenuzidwa komanso kubwezeretsedwa . Zapangitsa kuti CR ipitirirebe kupulumuka (PFS) poyerekeza ndi chlorambucil, koma sizinapangitsepo mwayi wopulumuka (OS) pokhapokha atagwiritsidwa ntchito payekha.
Mankhwala ena ochokera m'banja lomwelo, Nipent (pentostatin,) amagwiritsidwanso ntchito ngati gawo la mankhwala a CLL.
Kusintha kwenikweni kwa mankhwala a CLL kunachitika pamene Cytoxan (cyclophosphamide) inawonjezeredwa pamodzi ndi fludarabine mankhwala. Pogwiritsa ntchito regimen ("FC" kapena "Flu / Cy"), kuyankhidwa kwa mankhwala kunayambika monga zikuwonetseredwa ndi CR, PFS, ndi OS. Kuphatikiza mankhwala awiriwa pamodzi kumayambitsa kuwonjezeka kwa poizoni, sizikuwoneka kuti zimayambitsa matenda oopsa kwambiri.
Matenda a Monoclonal
Zotsatira za mankhwala a CLL zathandizidwa bwino ndi kuwonjezereka kwa chithandizo chamankhwala cha monoclonal antibody.
Mankhwala a monoclonal ndiwo maseŵera olimbana ndi khansa. Ngakhale kuti chitetezo cha mthupi chimazindikira mapuloteni osadziwika pamwamba pa mabakiteriya kapena kachilomboka, mankhwalawa "amazindikira" zosaoneka bwino pa maselo a khansa. Kuwonjezera kwa mankhwala a monoclonal Rituxan (rituximab) ku regimen ("FCR" protocol) wapereka anthu omwe ali ndi CLL mayankhidwe a 90% ndi 96% ndipo CR ya 50% ndi 70%.
Kachilombo kena kamodzi kake, Campath (alemtuzumab) yavomerezedwa ndi US Food and Drug Administration (FDA) yogwiritsira ntchito mankhwala a CLL. Cholinga chake chimagwiritsidwa ntchito pa "kansalu" ya antigen yosiyana ndi ya rituximab, ndipo ingagwiritsidwe ntchito yokha kapena yogwirizana ndi chemotherapy.
Kusuntha kwa Cell Shem
Pankhani ya mitundu ina ya khansa yamagazi, kufufuza kwakukulu kwakhala kochitidwa poyerekeza zotsatira zapulumuka za odwala omwe amalandira mankhwala a chemotherapy, motsutsana ndi kusamba maselo . Popeza kuti msinkhu wa wodwala CLL watsopano wapezeka ali pakati pa 65 ndi 70, omwe amakhala okalamba kwambiri kuti asatengeke ngati wophunzira, izi sizinayambe kuchitidwa.
Atanena zimenezi, 40% ya odwala CLL ali ndi zaka zopitirira 60 ndipo 12% ali ndi zaka zosakwana 50. Kulowetsa maselo amsampato kungapereke mpata wothandizira odwala CLL omwe ali ndi vuto loipa.
Kulowetsa maselo a m'magazi (kugwiritsidwa ntchito pogwiritsa ntchito maselo amodzi opatsa mphamvu) amagwiritsira ntchito kwambiri mankhwala a chemotherapy kuti athetse khansa ya m'magazi ndi maselo opatsirana opatsirana kuti asinthire chitetezo cha mthupi. Kupindula kwa kusakanikirana kwa maselo a m'magazi ndikuti ngakhale pangakhale poizoni kwambiri, zingayambitse zotsatira za "kuphatikiza ndi leukemia". Izi zikutanthauza kuti maselo opatsirana amagawenga amazindikira kuti maselo a khansa ya m'magazi ndi osalimba komanso amawaukira.
Ngakhale kuti njirayi ikukula bwino, pali mavuto ena akuluakulu oposa 15 mpaka 25%, omwe amachititsa kuti mliriwo ukhale ndi matenda omwe amachititsa kuti odwalawo akhale achilendo komanso kuti awonongeke.
Chifukwa cha zotsatira zoyipa za poizoni zopangidwa ndi allogeneic stem cell, sizikuwonetseratu kuti zipindulitse zotsatira za odwala okalamba.
Pakalipano, kufufuza kuti mudziwe kuti ntchito yopanga mankhwala osagwiritsidwa ntchito , kapena "mini" mu CLL ikuchitika. Zosasintha zokhudzana ndi matendawa zimadalira pang'ono poizoni wa chemotherapy ndi zambiri pa zotsatira za "kuphatikizapo khansa ya m'magazi" pofuna kuchiza khansa. Mankhwalawa akhoza kupereka chithandizo cha mankhwala kwa anthu achikulire omwe sangathe kulekerera kuikidwa kwachibadwa.
Mavitamini opangidwa ndi maselo otchedwa Autologous stem transplants pakuthandizidwa kwa CLL asonyeza zotsatira zosauka komanso kuchuluka kwa matenda obwereza, nthawi zina ngakhale zaka zitatha. Ngakhale kuti zikhoza kuchepetsa kupha, kutsegula kwa autologous sikungathandize kwambiri pakuchulukitsa CLL kusiyana ndi mankhwala osagwiritsa ntchito myeloablative . Chotsatira chake, kuika kwa autologous sikunali kovomerezeka kwa odwala CLL.
Mankhwala Opanga Mafuta
Kwa odwala omwe ali ndi CLL, kugwiritsa ntchito mankhwala opangira ma radiation kumangopereka kupereka mpumulo wa zizindikiro. Angagwiritsidwe ntchito pochiza malo omwe amayamba kutupa omwe amachititsa kuti munthu asamavutike kapena asokoneze kuyenda kapena kugwira ntchito kwa ziwalo zozungulira.
Splenectomy
Kwa odwala omwe ali ndi nthenda yotambasula chifukwa cha kusungunula kwa maselo a CLL, splenectomy , kapena kuchotsa opaleshoni ya nthata, amatha kuthandizira kukonzetsa magazi ndi kuchepetsa mavuto ena. Mofanana ndi mankhwala opatsirana ndi mpweya, splenectomy imagwiritsidwa ntchito kuthandizira kuthetsa zizindikiro za matendawa ndipo sichipereka mankhwala a khansa ya m'magazi.
Kuwongolera Iwo
Panthawiyi, pamene chithandizo cha CLL chikhoza kuthandiza odwala omwe ali ndi matenda opatsirana pogonana komanso odwala matenda a khansa, sangathe kuchiritsa, ndipo matendawa ndi osiyana kwambiri pakati pa anthu osiyanasiyana. Komabe, kumvetsetsa kwathu kwa mtundu umenewu wa khansa ya m'magazi kumapitiriza kukula. Kugwiritsira ntchito, mwachitsanzo, za maselo osungira maselo kwa anthu omwe ali ndi CLL amakula bwino pakati pa 2006 ndi 2016. Maphunziro a kafukufuku adzapitirirabe ndipo akhoza kupereka chithandizo chamankhwala ndi nthawi yayitali kapena kuchiza kwa CLL.
Zotsatira
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Lin, T., Byrd, J. "Chronic Lymphocytic Leukemia ndi Related Chronic Leukemias" ku Chang, A., Hayes, D. Pass, H. et al. eds. (2006) Oncology: Umboni Wopereka Umboni Wochokera ku Springer: New York. pp. 1210- 1228.
Hillman, R., Ault, K. (2002) Hematology mu Chipatala Chachitatu. McGraw-Hill: New York.
National Cancer Institute. Matenda a Lymphocytic Leukemia Treatment (PDQ) - kwa azachipatala. Kusinthidwa 01/29/16. http://www.cancer.gov/types/leukemia/hp/cll-treatment-pdq
Le Dieu, R., ndi Gribben, J., "Transplantation mu Chronic Lymphocytic Leukemia" Yamakono Achilengedwe Malignancy Reports 2007; 2: 56-63
Zent, C., Kay, N. "Chronic Lymphocytic Leukemia: Biology ndi Mmene Akuchiritsidwa" Magazini Yamakono Oncology 2007; 9: 345-352.